Novel Allograft in the Load-Bearing Portion of the Femoral Head

Abstract

Background: An osteochondral defect in the hip can be a painful and limiting pathologic process. The damaged joint may progress into premature osteoarthritis, further limiting a patient's functionality. Case Report: A 24-year-old male presented to the clinic with left hip pain. The patient had been involved in a motor vehicle accident 3 years prior to presentation to our clinic. His injury from the high-speed accident required intramedullary rod fixation for a right-sided (contralateral) subtrochanteric femur fracture. The patient complained of left groin pain when in a sitting position, with activities of daily living, and with exercise. He failed conservative management consisting of nonsteroidal anti-inflammatory drugs and physical therapy. Imaging on presentation demonstrated an osteochondral defect in the weight-bearing portion of the left femoral head consistent with an International Cartilage Repair Society grade 4b lesion, a cam lesion was noted on assessment of bone morphology, and magnetic resonance imaging revealed degenerative labral pathology. The patient was treated with surgical hip dislocation through a modified Hardinge approach, femoral head osteochondral allograft transplantation using a Missouri Osteochondral Preservation System (MOPS) graft, acetabuloplasty, femoral neck osteoplasty, and open labral repair. Conclusion: Femoral head osteochondral MOPS allograft transplantation is a viable technique for joint preservation in young patients with posttraumatic osteochondral defects of the femoral head.